Kōbe-shi, Japan
Kōbe-shi, Japan

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Yamamoto J.,Kobe Gakuin University | Inoue N.,Kobe Rosai Hospital | Otsui K.,Kobe Rosai Hospital | Ishii H.,Ishii Hospital | And 2 more authors.
Thrombosis Research | Year: 2014

Background Detection of both thrombosis and bleeding risk are essential in clinical cardiology. Thrombin generated by activated platelets and from the extrinsic coagulation pathway is the major determinant of thrombogenesis and hemostasis. Although novel oral anticoagulants further increase the bleeding risk of antiplatelet drugs, platelet function tests do not reliably predict hemorrhagic complications. It seems that in addition to platelet aggregation, true assessment of bleeding risks requires the measurement of both platelet and plasma derived thrombin activity. Objective To adapt a novel, near-patient test for the assessment of both antithrombotic and anticoagulant effects of oral thrombin inhibitors. Methods The point-of-care Global Thrombosis Test (GTT), which measures platelet reactivity to shear-activation in native blood, was used. Thrombin, generated from activated platelets (procoagulant activity) plays a pivotal role in GTT measurement. In order to assess endogenous thrombin potential, in a separate blood sample thrombin generation was induced by microparticles formed during hypotonic hemolysis. Thus two blood samples were tested to measure simultaneously platelet reactivity (occlusion time, OT) and hemolysis (microparticles)-induced endogenous thrombin potential (OT-H). Results In healthy subjects (n = 32), OT measured in native blood was reduced in hemolysed blood (100% vs. 43 ± 4%; OT vs. OT-H respectively). Shortening of OT in hemolysed blood (OT-H) was dose-dependently inhibited by the in vitro added thrombin inhibitor argatroban. In patients receiving dabigatran (n = 27), OT and, to a lesser extent, OT-H was prolonged, compared to healthy volunteers. Intra-assay variation of OT-H was low (4.5%), but interindividual variation was great, both in healthy subjects (61%) and in patients on dabigatran (65%). Thrombin inhibitors argatroban, heparin (in vitro) and dabigatran (in vivo) all prolonged both OT and OT-H. There was no correlation between the measured OT and OT-H data. Conclusions Microparticles shed from erythrocytes during hypotonic lysis of native blood considerably shortened OT. In a direct proportion to the applied concentrations, various thrombin inhibitors prolonged both OT (antithrombotic effect) and to a lesser extent, OT-H (anticoagulant effect). Further large studies are required to evaluate the usefulness of this technique in a clinical setting, in assessing the anticoagulant and antithrombotic effects of medication and relating GTT results with observed thrombotic and bleeding events. © 2014 Elsevier Ltd. All rights reserved.

Miyamoto H.,Kinki University | Maeno K.,Kobe University | Uno K.,National Hospital Organization | Kakutani K.,Kobe University | And 2 more authors.
European Spine Journal | Year: 2014

Purpose: The surgical strategy for cervical spondylotic myelopathy (CSM) accompanying local kyphosis is controversial. The purpose of the present study was to compare and evaluate the outcomes of two types of surgery for CSM accompanying local kyphosis: (1) laminoplasty alone (LP) and (2) posterior reconstruction surgery (PR) in which we corrected the local kyphosis using a pedicle screw or lateral mass screw. Methods: Sixty patients who presented with local kyphosis exceeding 5 were enrolled. LP and PR were each performed on a group of 30 of these patients; 30 CSM patients without local kyphosis, who had undergone LP, were used as controls. The follow-up period was 2 years or longer. Preoperative local kyphosis angles in LP and PR were 8.3 ± 4.4 and 8.8 ± 5.7, respectively. Preoperative C2-7 angles in LP, PR and controls were -1.7 ± 9.6, -0.4 ± 7.2 and -12.0 ± 5.6, respectively. The recovery rate of the JOA score, local kyphosis angle and C2-7 angle at post-op and follow-up were compared between the groups. Results: The recovery rate of the JOA score in the LP group (32.6 %) was significantly worse than that in the PR group (44.5 %) and that of controls (53.8 %). Local kyphosis angles in the PR and LP groups at follow-up were 4.0 ± 8.6 and 8.0 ± 6.0, respectively. However, although the C2-7 angle at follow-up was improved to -11.1 ± 12.7 in PR, and maintained at -11.6 ± 6.2 in controls, it deteriorated to 0.5 ± 12.7 in LP. Conclusions: The present study is the first to compare the outcomes between LP alone and PR for CSM accompanying local kyphosis. It revealed that PR resulted in a better clinical outcome than did LP alone. This result may be due to reduction of local kyphosis, stabilization of the unstable segment, and/or the maintenance of C2-7 angle until follow-up in the PR group. © 2013 Springer-Verlag Berlin Heidelberg.

Miyamoto H.,National Hospital Organization Kobe Medical Center | Sumi M.,Kobe Rosai Hospital | Uno K.,National Hospital Organization Kobe Medical Center
Spine Journal | Year: 2013

Background context: Surgical intervention is a therapeutic choice for atlantoaxial subluxation (AAS), vertical subluxation (VS), and subaxial subluxation (SAS) associated with rheumatoid cervical spine. However, the long-term outcomes of different subgroups remain unclear, although rheumatoid arthritis (RA) is a progressive disease even after surgery. Purpose: To evaluate the outcomes of surgery for various subgroups of rheumatoid cervical spine, performed at a single institute over three decades. Study design: Retrospective clinical analysis. Patient sample: One-hundred eighteen seropositive RA patients treated at one institute over the past three decades. Atlantoaxial fixation was performed in 28 AAS patients. Occipitospinal fusion was performed in 41 irreducible AAS or VS patients. Laminotomy with autologous bone fusion was performed in 22 patients, anterior fusion in 5, laminoplasty in 4, and posterior decompression/fusion with instrumentation in 12 with SAS. Methods: Clinical outcomes using the Japanese Orthopedic Association score, complications, deterioration of RA, and mortality rate during the follow-up were investigated from preoperation to more than 10 years after surgery in the subgroups. Outcome measures: Outcomes were compared among the subgroups. Results: Patients with AAS exhibited significantly better clinical outcomes throughout the follow-up period compared with patients from the other subgroups. Patients with SAS had the worst neurologic status even at preoperation, and the symptomatic improvement achieved by surgery deteriorated within less than 5 years. Deterioration of outcome was caused by occurrence of complications and deterioration of RA during the follow-up. The mortality rates at 5 and 10 years after surgery were 20% and 33%, respectively. Conclusions: The outcome of surgery for rheumatoid cervical spine was different in the various subgroups and associated with the occurrence of complications and deterioration of RA. © 2013 Elsevier Inc. All rights reserved.

Inui Y.,National Hospital Organization Kobe Medical Center | Miyamoto H.,National Hospital Organization Kobe Medical Center | Sumi M.,Kobe Rosai Hospital | Uno K.,National Hospital Organization Kobe Medical Center
Spine | Year: 2011

Study Design.: Retrospective clinical analyses of patients with cervical spondylotic amyotrophy (CSA). Objective.: To report the clinical outcomes and predictive factors relating to the prognosis in conservative and surgical treatments for CSA. Summary OF Background Data.: CSA is a clinical entity characterized by muscle atrophy in the upper extremity without marked sensory disturbance or spastic tetraparesis. The indications for, and outcomes of conservative and surgical treatments for CSA have not been clearly enunciated. Methods.: Ninety patients with CSA were enrolled in this study. All of them initially received continuous cervical traction for 2 to 3 weeks as inpatients. If this conservative treatment was ineffective, surgical intervention was carried out after informed consent was obtained. We investigated the outcome of conservative treatment, the predictive factors relating to the prognosis of the conservative treatment, and the outcome of surgery after initial conservative treatment failed. Results.: After initial conservative treatment, 42 patients (46.7%) showed excellent or good outcome, 29 patients underwent surgery, and 19 patients declined surgery. Consequently, 61 patients were conservatively followed up. At final follow-up, 40% of the patients still showed excellent or good neurologic status by conservative treatment, and this group was characterized by age <50 years, duration of symptoms <6 months, single-level stenosis, foraminal stenosis, and a good response to traction therapy. Additional 5 patients underwent surgery during follow-up because of deterioration of symptom, and 34 patients consequently underwent surgery at the final follow-up. Of 34, 28 (82%) patients who underwent surgery obtained neurologic improvement. Conclusion.: The present study has demonstrated the outcome of conservative and of surgical treatments for CSA, together with the predictive factors relating to the prognosis. Conservative treatment should be initially tried on CSA patients, especially those with predictive factors relating to a better prognosis. However, if conservative treatment failed, surgical intervention was successful. Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Honjo T.,Kobe University | Yamaoka-Tojo M.,Kitasato University | Inoue N.,Kobe Rosai Hospital
Current Vascular Pharmacology | Year: 2011

The renin-angiotensin system (RAS) plays an essential role in fluid and electrolyte homeostasis and the regulation of vascular tone; however, dysregulation and over-activation of the RAS lead to the pathogenesis of various cardiovascular diseases. The RAS is closely associated with NADPH oxidase, a major enzymatic source of reactive oxygen species (ROS) in vasculature, and angiotensin II, the final effecter of the RAS, is a potent stimulator of this oxidase. There are accumulating evidences to support the significance of NADPH oxidase in the pathogenesis of atherosclerosis. We demonstrated that the expression of NADPH oxidase is markedly enhanced in human atherosclerotic coronary arteries, and the distribution of oxidized oxidized low-density lipoprotein (LDL) in vasculature is closely associated with NAPDH oxidase and ROS. Our series of observations indicate there is a vicious circle consisting of vascular NADPH oxidase, the RAS, ROS, and oxidized LDL. Furthermore, we demonstrated that angiotensin II type 1 receptor blockers (ARBs) significantly suppressed the expression of NADPH oxidase p22 phox in the aortic walls of patients with thoracic aortic aneurysm. ARBs, widely used for treatment of hypertension and hypertension-related organ damage, have succeeded in reducing the onset of cardiovascular diseases, preventing organ damage, and cardiac death. These beneficial effects of ARBs are largely dependent upon their primary effects of blood pressure lowering. However, this group of agents exerts a wide variety of biological effects on vascular metabolism, including antioxidative and anti-inflammatory actions. These pleiotropic actions play a role in cardiovascular protection. From a viewpoint of oxidative stress, we discuss pleiotropic effects of ARBs on vascular metabolism focusing on pathogenesis of atherosclerosis-based cardiovascular diseases. © 2011 Bentham Science Publishers Ltd.

Inoue N.,Kobe Rosai Hospital
Journal of Atherosclerosis and Thrombosis | Year: 2014

Recent major advances in medical science have introduced a wide variety of treatments against atherosclerosis- based cardiovascular diseases, which has led to a significant reduction in mortality associated with these diseases. However, atherosclerosis-based cardiovascular disease remains a leading cause of death. Furthermore, progress in medical science has demonstrated the pathogenesis of cardiovascular disease to be complicated, with a wide variety of underlying factors. Among these factors, stress is thought to be pivotal. Several types of stress are involved in the development of cardiovascular disease, including oxidative stress, mental stress, hemodynamic stress and social stress. Accumulating evidence indicates that traditional risk factors for atherosclerosis, including diabetes, hyperlipidemia, hypertension and smoking, induce oxidative stress in the vasculature. Oxidative stress is implicated in the pathogenesis of endothelial dysfunction, atherogenesis, hypertension and remodeling of blood vessels. Meanwhile, mental stress is a well-known major contributor to the development of cardiovascular disease. The cardiovascular system is constantly exposed to hemodynamic stress by the blood flow and/or pulsation, and hemodynamic stress exerts profound effects on the biology of vascular cells and cardiomyocytes. In addition, social stress, such as that due to a lack of social support, poverty or living alone, has a negative impact on the incidence of cardiovascular disease. Furthermore, there are interactions between mental, oxidative and hemodynamic stress. The production of reactive oxygen species is increased under high levels of mental stress in close association with oxidative stress. These stress responses and their interactions play central roles in the pathogenesis of atherosclerosis-based cardiovascular disease. Accordingly, the pathophysiological and clinical implications of stress are discussed in this article.

STUDY DESIGN.: Kinematic analysis of swallowing function using videofluoroscopic swallowing study (VFSS). OBJECTIVE.: To analyze swallowing process in the patients who underwent occipitospinal fusion (OSF) and elucidate the pathomechanism of dysphagia after OSF. SUMMARY OF BACKGROUND DATA.: Although several hypotheses about the pathomechanisms of dysphagia after OSF were suggested, there has been little tangible evidence to support these hypotheses since these hypotheses were based on the analysis of static radiogram or CT. Considering that swallowing is a compositive motion of oropharyngeal structures, the etiology of postoperative dysphagia should be investigated through kinematic approaches. METHODS.: Each four patients with or without postoperative dysphagia (group D and N respectively) participated in this study. For VFSS, all patients were monitored to swallow 5-ml diluted barium solution by fluoroscopy, and then dynamic passing pattern of the barium solution were analyzed. Additionally, O-C2 angle (O-C2A) was measured for the assessment of craniocervical alignment. RESULTS.: O-C2A in group D was -7.5 degrees, which was relatively smaller than 10.3 degrees in group N (P?=?0.07). In group D, all cases presented smooth medium passing without any obstruction at the upper cervical level regardless of O-C2A, whereas the obstruction to the passage of medium was detected at the apex of mid-lower cervical curvature, where the anterior protrusion of mid-lower cervical spine compressed directly the pharyngeal space. In group N, all cases showed smooth passing of medium through the whole process of swallowing. CONCLUSION.: This study presented postoperative dysphagia did not occur at the upper cervical level even though there was smaller angle of O-C2A and demonstrated the narrowing of the oropharyngeal space due to direct compression by the anterior protrusion of mid-lower cervical spine was the etiology of dysphagia after OSF. Therefore, surgeon should pay attention to the alignment of mid-cervical spine as well as craniocervical junction during OSF.Level of Evidence: 4 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Ozaki N.,Kobe Rosai Hospital | Wakita N.,Kobe Rosai Hospital | Yamada A.,Kobe Rosai Hospital | Tanaka Y.,Kobe Rosai Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2010

Three patients had severe abdominal pain of sudden onset. Computed tomography showed localized dissection in the superior mesenteric artery in two patients and in the celiac artery in one. With conservative therapy abdominal symptoms were self-remitted. All patients were successfully treated with medication and have been doing well during follow-up. © 2010 Published by European Association for Cardio-Thoracic Surgery.

STUDY DESIGN.: Clinical case series and risk factor analysis of dysphagia after occipitospinal fusion (OSF). OBJECTIVE.: To develop new criteria to avoid postoperative dysphagia by analyzing the relationship among the craniocervical alignment, the oropharyngeal space and the incidence of dysphagia after OSF. SUMMARY OF BACKGROUND DATA.: Craniocervical malalignment after OSF is considered to be one of the primary triggers of postoperative dysphagia. However, ideal craniocervical alignment has not been confirmed. METHODS.: Thirty-eight patients were included. We measured the O-C2 angle and the pharyngeal inlet angle (PIA) on the lateral cervical radiogram at follow-up. PIA is defined as the angle between McGregorʼs line and the line that links the center of the C1 anterior arch and the apex of cervical sagittal curvature. The impact of these two parameters on the diameter of pharyngeal airway space (PAS) and the incidence of the dysphagia were analyzed. RESULTS.: Six of 38 cases (15.8%) exhibited the dysphagia. A multiple regression analysis showed that PIA was significantly correlated with PAS (β=0.714, P?=?0.005). ROC curves showed that PIA had a high accuracy as a predictor of the dysphagia with an AUC (area under the curve) of 0.90. Cases with a PIA less than 90 degrees showed significantly higher incidence of dysphagia (31.6%) than those with a 90 or more degrees of PIA (0.0%) (P?=?0.008). CONCLUSION.: Our results indicated that PIA had the high possibility to predict postoperative dysphagia by OSF with the condition of PIA below 90 degrees. Based on these results, we defined “Swallowing-line (S-line)” for the reference of 90 degrees of PIA. S-line (-) is defined as PIA less than 90 degrees, where the apex of cervical lordosis protruded anterior to the “S-line”, which should indicate the patient is at a risk of postoperative dysphagia.Level of Evidence: 4 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Kawai Y.,Kobe Rosai Hospital | Inoue N.,Kobe Rosai Hospital | Onishi K.,Kobe Rosai Hospital
Congestive Heart Failure | Year: 2012

The number of super-elderly patients older than 80years with chronic heart failure (HF) is dramatically increased in Japan; however, therapeutic strategies for patients 80years or older remains to be established. The present investigation was undertaken to clarify the clinical picture and socioeconomic characteristics of super-elderly HF patients. A total of 380 consecutive patients with acute HF or acutely worsening chronic HF were divided into three groups according to age: patients younger than 60years, those 60 to 80years, and those 80years or older (super-elderly group). HF patients in the super-elderly group initially presented with more atypical symptoms at admission compared with those in the younger age group. The prevalence of HF with preserved ejection fraction was more pronounced compared with the patients in the younger age group. Furthermore, the social background was quite different for the 3 groups in several respects: recurrent hospitalization, the prevalence of dementia, and the number of patients living alone all increased with age. The lack of social support in patients with HF is a problem that needs to be resolved in the "super-graying" societies such as Japan. © 2012 Wiley Periodicals, Inc.

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